Purpose

To standardize evidence-informed best practices related to stroke care across the continuum in Southern Health-Santé Sud through:

• Access to stroke prevention clinics.
• Early recognition of stroke irrespective of where in the continuum of services the patient accesses care.
• Timely access to a stroke centre for key assessments and interventions.
• Effective post-stroke care aimed at rehabilitation to maximize recovery and potential.
• Facilitated reintegration into the community.

Policy Number

CLI.4110.PL.013

Background

• Per Shared Health direction to reflect updated best practice guidelines

Key Message

• The thrombolytic agent for stroke is switching from Alteplase (tPA)to TNK. Be cautious as the dose for TNK differs for Ischemic Strokevs. Acute Coronary Syndrome.
• Updated Blood pressure requirements, pre thrombolysis, changedto 185/110. Post thrombolysis remains 185/105.
• Updated ‘evaluation’ section in the guideline to reflect newregional audit process.
• Update wording on expanding endovascular therapy treatmentwindow up to 24 hours in some cases. Standard is still 6 hours forrural MB. A CT perfusion scan is required in order to determine ifthe patient is a candidate. This is only done at HSC currently.
• Therapeutic window for TNK is still 4.5, in some cases this windowmay be extended up to 9 hours from last seen normal.
• Updated Intracerebral hemorrhage treatment options, differs from Winnipeg due to limited access to Platelets in rural.
• Clinical MUST indicate Stroke Protocol on the lab requisition to alert the laboratory.
• Lab has internal processes for stroke protocol when INR is selected on requisition.
• Changed transport directions from MTCC to VECTRS and updated contact information/process
• Added LAMS assessment into Stroke Centres Emergency Standard Orders CLI.4110.PL.013.FORM.07 LAMS score of 4 or greater predicted a large vessel occlusion.
• Atypical Stroke symptoms added into Stroke Centres Emergency Standard Orders CLI.4110.PL.013.FORM.07and Acute Stroke Care Map for Emergency Departments at Non Stroke Centres CLI.4110.PL.013.FORM.01
• Clarification on language in CTAS and EDIS for patients who present with symptoms of CVA. CTAS 1 (per EDISand provincial decision) for all patients with symptoms of CVA within the therapeutic window. CTAS 3 forpatients presenting outside the therapeutic window or if symptoms have resolved.

Recommendation(s)/Action Required

• Discard any preprinted old forms, standard orders and replace with updated versions.
• Archive Role of Alteplase tPA in Stroke Care Information for Patients and Families BilingualCLI.4110.PL.013.SD.03
• Read only’ changes – Managers and CRNs please ensure your physicians and nurses at your sites are awareof this change.
• Pharmacy – please ensure TNK is available within Regional and Community Acute Emergency Departments.
• Ensure the updated parenteral drug monograph for TNK for ischemic stroke is in the monograph binders and on StaffNET webpage
• Lab to ensure fibrinogen 8g available at regional centres (2 full doses) for ICH treatment.
• Links to Shared Health Stroke guidelines will be added into the guideline once finalized.

Timeline:

• Roll out October 14, 2025 or as soon as communication is complete

If you have any questions, please contact: Kim Dorion, Regional Critical Care Education Facilitator

Submitted by: Acute Care & Chief Nursing Officer